Skip to main content
SpringerLink
Log in

Screening for prostate cancer: Updated experience from the Tyrol study

  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

The aim of the Tyrol study was to monitor the impact of screening in a natural experiment by comparing prostate cancer mortality in Tyrol, where prostate-specific antigen (PSA) testing was introduced at no charge, with the rest of Austria, where it was not strictly organized and not free of charge. In 1993, PSA testing was made freely available to men between the ages of 45 and 75 years in the Federal State of Tyrol, Austria. At least 70% of all of the men in this age range have been tested at least once during the first 10 years of the study. Initially, only total PSA was measured, but free PSA measurement was added in 1995. Since 2001, complexed PSA also has been measured. Digital rectal examination was not part of the screening examination. Significant migration to lower clinical and pathological stages has been observed since the introduction of this screening program. These findings are consistent with the hypothesis that the policy of making PSA testing freely available, and the wide acceptance by men in the population, is associated with a reduction in prostate cancer mortality in an area in which urology services and radiotherapy are available freely to all patients. It is our opinion that most of this decline is likely a result of aggressive downstaging and successful treatment and that any contribution from detecting and treating early cancers will become apparent in the years to come.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Stanford JL, Stephenson RA, Coyle M, et al.: Prostate Cancer Trends 1973–1995, SEER Program. NIH Publication No. 99-4543. Bethesda: National Cancer Institute; 1999:7–15.

    Google Scholar 

  2. Jones GW, Mettlin C, Murphy GP, et al.: Patterns of care for carcinoma of the prostate gland: results of a national survey of 1984 and 1990. J Am Coll Surg 1995, 180:545–554.

    PubMed  CAS  Google Scholar 

  3. Catalona WJ, Richie JP, Ahmann FR, et al.: Comparison of digital rectal examination and serum prostate specific antigen in the early detection of prostate cancer: results of a multicenter clinical trial of 6630 men. J Urol 1994, 151:1283–1290.

    PubMed  CAS  Google Scholar 

  4. Ohori M, Wheeler TM, Dunn JK, et al.: The pathological features and prognosis of prostate cancer detectable with current diagnostic tests. J Urol 1994, 152:1714–1720.

    PubMed  CAS  Google Scholar 

  5. Smith DS, Catalona WJ: The nature of prostate cancer detected through prostate specific antigen based screening. J Urol 1994, 152:1732–1736.

    PubMed  CAS  Google Scholar 

  6. Slawin KM, Ohori M, Dillioglugil O, et al.: Screening for prostate cancer: an analysis of the early experience. CA Cancer J Clin 1995, 45:134–147.

    PubMed  CAS  Google Scholar 

  7. Reissigl A, Pointner J, Horninger W, et al.: Comparison of different PSA cut points for early detection of prostate cancer: results of a large screening study. Urology 1995, 46:662–665.

    Article  PubMed  CAS  Google Scholar 

  8. Reissigl A, Pointner J, Horninger W, et al.: PSA based screening for prostate cancer in asymptomatic younger males: pilot study in blood donors. Prostate 1997, 30:20–25.

    Article  PubMed  CAS  Google Scholar 

  9. Reissigl A, Ennemoser O, Klocker H, et al.: Frequency and clinical significance of transition zone cancer in prostate cancer screening. Prostate 1997, 30:130–135.

    Article  PubMed  CAS  Google Scholar 

  10. Reissigl A, Klocker H, Horninger W, et al.: Usefulness of the ratio free/total PSA in addition to total PSA levels in prostate cancer screening. Urology 1996, 48:62–66.

    Article  PubMed  CAS  Google Scholar 

  11. Horninger W, Reissigl A, Klocker H, et al.: Improvement of specificity in PSA based screening by using PSA transition zone density and percent free PSA in addition to total PSA levels. Prostate 1998, 37:133–137.

    Article  PubMed  CAS  Google Scholar 

  12. Oesterling JE, Jacobsen SJ, Chute CG, et al.: Serum prostate specific antigen in a community-based population of healthy men: establishment of age specific reference ranges. JAMA 1993, 270:860–864.

    Article  PubMed  CAS  Google Scholar 

  13. Horninger W, Reissigl A, Rogatsch H, et al.: Prostate cancer screening in the federal state of Tyrol, Austria. Eur J Cancer 2000, 36:1322–1335. This paper describes the development of a screening program with all of the problems and successes.

    Article  PubMed  CAS  Google Scholar 

  14. Boyle P, Parkin DM: Statistical methods for registries. In Cancer Registration: Principles and Methods, no 95. Edited by Jensen OM, Parkin DM, McLennan R, et al. Lyon: IARC Scientific Publication; 1995:126–158.

    Google Scholar 

  15. McCullagh P, Nelder JA: Generalized Linear Models, edn 2. London: Chapman and Hall; 1989.

    Google Scholar 

  16. Splus 2000: User’s Guide. Seattle: Data Analysis Products Division, Mathsoft; 1999.

  17. Boyle P, Severi G: Epidemiology of chemoprevention of prostate cancer. Eur Urol 1999, 35:370–376.

    Article  PubMed  CAS  Google Scholar 

  18. Catalona WJ, Smith DS, Ratliff TL, et al.: Measurement of prostate specific antigen in serum as a screening test for prostate cancer. N Engl J Med 1991, 324:1156–1161.

    Article  PubMed  CAS  Google Scholar 

  19. Mettlin C, Murphy GP, Babaian RJ, et al., for the Investigators of the American Cancer Society National Prostate Cancer Detection Project: The results of a five-year early prostate cancer detection intervention. Cancer 1996, 77:150–159.

    Article  PubMed  CAS  Google Scholar 

  20. Wilson JM, Jungner G: Principles and Practice of Screening for Disease, Public Health Paper No. 34. Geneva: World Health Organization; 1969.

    Google Scholar 

  21. Von Eschenbach A, Ho R, Murphy GP, et al., for the American Cancer Society: Guidelines for the early detection of prostate cancer. Cancer 1997, 80:1805–1807.

    Article  Google Scholar 

  22. Smart CR: The results of prostate carcinoma screening in the U.S. as reflected in the surveillance, epidemiology, and end results program. Cancer 1997, 80:1835–1844.

    Article  PubMed  CAS  Google Scholar 

  23. Hankey BF, Feuer EJ, Clegg LX, et al.: Cancer surveillance series: interpreting trends in prostate cancer-part I. Evidence of the effects of screening in recent prostate cancer incidence, mortality, and survival rates. J Natl Cancer Inst 1999, 91:1017–1024. This paper explains the effect of screening on incidence rates and mortality rates. This paper is a prerequisite to understanding screening program effects.

    Article  PubMed  CAS  Google Scholar 

  24. Feuer J, Merrill RM, Hankey BF: Cancer surveillance series: interpreting trends in prostate cancer-part II. Cause of death misclassification and the recent rise and fall in prostate cancer mortality. J Natl Cancer Inst 1999, 91:1025–1032. This paper describes the reasons of prostate cancer deaths misclassification.

    Article  PubMed  CAS  Google Scholar 

  25. Etzioni R, Legler JM, Feuer EJ, et al.: Cancer surveillance series: interpreting trends in prostate cancer-part III: quantifying link between population prostate specific antigen testing and recent declines in prostate cancer mortality. J Natl Cancer Inst 1999, 91:1033–1039.

    Article  PubMed  CAS  Google Scholar 

  26. Jacobsen SJ, Bergstralh EJ, Katusic SK, et al.: Screening digital rectal examination and prostate cancer mortality: a population-based case-control study. Urology 1998, 52:173–179.

    Article  PubMed  CAS  Google Scholar 

  27. Boyle P: Prostate-specific antigen (PSA) testing as screening for prostate cancer: the current controversy. Ann Oncol 1998, 9:1263–1264.

    Article  PubMed  CAS  Google Scholar 

  28. Laara E, Day NE, Hakama M: Trends in mortality from cervical cancer in the Nordic countries: association with organized screening programs. Lancet 1987, 1:1247–1249.

    PubMed  CAS  Google Scholar 

  29. van den Akker-van Marle E, de Konig H, Boer R, et al.: Reduction in breast cancer mortality due to the introduction of mass screening in The Netherlands: comparison with the United Kingdom. J Med Screen 1999, 6:30–34.

    PubMed  Google Scholar 

  30. Messing EM, Manola J, Sarosdy M, et al.: Immediate hormonal therapy compared with observation after radical prostatectomy and pelvic lymphadenectomy in men with node positive prostate cancer. N Engl J Med 1999, 341:1781–1788.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria

    Wolfgang Horninger MD

Authors
  1. Wolfgang Horninger MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andreas Berger MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexandre Pelzer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Helmut Klocker MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wilhelm Oberaigner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dieter Schönitzer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gianluca Severi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chris Robertson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Peter Boyle MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Georg Bartsch MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Horninger, W., Berger, A., Pelzer, A. et al. Screening for prostate cancer: Updated experience from the Tyrol study. Curr Urol Rep 5, 220–225 (2004). https://doi.org/10.1007/s11934-004-0040-8

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-004-0040-8

Keywords

Search

Navigation